Correlation of CD4+CD57+, CD8+CD57+, CD4+KLRG1+, CD8+KLRG1+ T Cells Percentage and Serum MMP-9 Level with Cognitive Dysfunction among Systemic Lupus Erythematosus Patients

Background: ‘Lupus brain fog’ is a phenomenon of cognitive function decline in SLE patients. Premature immunosenescence in SLE was presumed to play a significant role in the mechanism of cognitive dysfunction. Aim: To prove the correlation between the terminally-differentiated CD4+CD57+, CD8+CD57+, CD4+KLRG1+, and CD8+KLRG1+ T cells & serum levels of MMP-9 with cognitive dysfunction in SLE patients. Methods: 53 women SLE were conducted to perform MMSE and MoCA-Ina tests to evaluate cognitive function. Immunosenescence was observed by measuring the terminallydifferentiated CD4+CD57+, CD8+CD57+, CD4+KLRG1+, and CD8+KLRG1+ T cells, which were measured by flowcytometry. In addition, MMP-9, an enzyme produced by terminallydifferentiated T cells, was measured using ELISA. Results: SLE patients with cognitive dysfunction based on MMSE and MoCA-Ina test had higher percentage of CD4+CD57+, CD8+CD57+, CD4+KLRG1+, CD8+KLRG1+ T cells and serum levels of MMP-9 compared to patients with normal cognitive function. CD4+CD57+, CD8+CD57+, CD4+KLRG1+, CD8+KLRG1+ T cells percentage and serum MMP-9 level showed negative correlation with both MMSE scores (r = -0.286; r = -0.447; r = -0.279; r = -0.537; r = 0,411) and MoCA-Ina scores (r = -0.454; r = -0.539; r = -0.435; r = -0.535; r = -0.648). Meanwhile, percentage of CD4+CD57+, CD8+CD57+, CD4+KLRG1+ and CD8+KLRG1+ T cells showed positive correlation with serum MMP-9 level (r = 0.292; r = 0.414; r = 0.449; r = 0.374). Conclusion: Expansion of CD4+CD57+, CD8+C57+, CD4+KLRG1+, CD8+KLRG1+ terminally differentiated T cells & increase of serum MMP-9 level are correlated with cognitive dysfunction in SLE patients

Factors Associated With Changes In Bone-Mass Density In Post Menopause Female Patients With Osteopenia

Background: Many factors can cause changes in bone mass density (BMD) in women with postmenopausal osteopenia. Aim: Determine factors associated with changes in BMD in postmenopausal women with osteopenia with the most influential risk factors within 1 year. Methods: Survey was conducted on 38 patients who were included in the inclusion criteria with a cross-sectional study analysis and had BMD data for the last 2 years, body mass index, and conducted interviews for physical activity, age of menopause, and duration of menopause. Blood samples were also taken to check total calcium levels, vitamin D levels and estrogen levels. Finally, patients are followed for up to 1 week for daily nutrition records. The relationship between these factors and changes in BMD was analyzed using Pearson's or Spearman's test. The analysis result was considered significant if p<0.05. Results: There was no significant relationship between body mass index, menopause duration, physical activity, dietary calcium, serum calcium levels and serum estradiol levels on changes in BMD with p value > 0.05. However, there was a significant relationship between menopause onset and changes in ward mass density (r = 0,321, p = 0,04) and lumbal 1 (r = 0,333, p = 0,04), serum vitamin D levels and changes in great trochanter mass density (r = 0,336, p = 0,036), physical activity score and changes in ward mass density (r = -0,522, p < 0,01). Conclusion: menopause onset, vitamin D and physical activity are significantly associated with changes in BMD in female patients with postmenopausal osteopenia.

The Diagnosis Algorithm of Chronic Hypokalemia in Bartter Syndrome and Gitelman Syndrome: A Case Report

Introduction: Hypokalemia is common disorder characterized by low plasma potassium levels (<3.5 mEq / L). Hypokalemia can be caused by genetic disorders. Bartter syndrome and Gitelman syndrome are rare genetic disorders that cause damage to the tubular kidneys. The cause of hypokalemia must be determined by analyzing the diagnosis algorithm of hypokalemia. Case Illustration: A 27-year-old woman was brought to the emergency room with complaints of weakness in both legs since 1 day ago. Obtained a history of chronic hypokalemia since 5 years ago. No history of thyroid disease, and never taking diuretic drugs. The patient is calm. Vital signs: BP: 110/60, regular pulse 88x/minute, temperature: 36.7°C, respiratory rate 14x/minute, oxygen saturation 99% in room air. ECG showed Normal sinus rhythm with normal T wave. Laboratory findings showed severe hypokalemia with plasma potassium 1.7 mEq/L, increased urine potassium (71.1 mmol/24 hours), increased urine sodium 306 mmol/24 hours, and increased urine chloride (342 mmol/24 hours), plasma magnesium levels were normal (1.91 mg/dL). KCl infusion was given to correct electrolyte imbalance condition. Discussion: : Several examinations must be performed to confirm the cause of hypokalemia condition. The diagnosis of this patient was suspected to lead to Bartter syndrome and Gitelman syndrome, because there was an increase in urinary potassium excretion, normotensive conditions, no suspicion of metabolic acidosis, and no symptoms of nausea and vomiting and no history of diuretic drugs usage. Keywords: Hypokalemia, Bartter syndrome, Gitelman syndrome

Molecular Docking Approach of Viscosin as Antibacterial for Methicillin-resistant Staphylococcus Aureus Via β-Lactamase Inhibitor Mechanism

Background: β-lactamase is an enzyme that plays a role in the occurrence of antibiotic resistance against Methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Viscosin is a lipopeptide biosurfactant produced by the Pseudomonas group bacteria. A study states that Viscosin has strong antibacterial properties. Aims: This study aims to determine the interactions that occur with Viscosin and β-lactamase enzymes. Methods: Researchers used the in-silico method to determine the molecular interactions that occurred computationally. The protein used was β-lactamase protein obtained from the Protein Data Bank and Viscosin ligand obtained from the PubChem web server, and we used native ligands as control. Pharma expert web server and Pyrx, Pymol, and Discovery Studio software were used in this research. Results: The results showed that Viscosin has high activity as an antibiotic and is predicted to be a membrane integrity antagonist. The binding affinity interaction that occurs between Viscosin-β-lactamase is -7.3 kcal/mol. The affinity is lower than the control. Conclusion: Viscosin was predicted to have strong antibacterial properties, but the binding interaction was lower than the control. However, exploration of Viscosin compounds and further research to determine the antibacterial effect of Viscosin against MRSA and other bacteria is needed to against antibiotic resistance.

Obesity and COVID-19: An Epidemic Aggravating A Pandemic

COVID-19 has been declared by WHO as a pandemic since March 2020. The pandemic has caused major deaths in the world and has become the candidate for the third largest pandemic in history after the Black Death pandemic and the Spanish Flu pandemic. Many conditions have made the deaths in the COVID-19 pandemic become large, including collision with the obesity epidemic. The aim of this literature review is to discuss the relationship between obesity as a risk factor for high mortality COVID-19 and its management.

The Effect of Soya and Genistein Supplementation on Serum Lipid Profile of Male Dawley Sprague Rat

Background: Non-medical therapy is needed to reduce blood lipid levels and prevent atherosclerosis. Foods that contain Isoflavones can improve lipid profiles in the blood. Aim: To determine the effect of soya and genistein supplementation in various doses on total cholesterol, Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Triglycerides in male Sprague-Dawley rats. Methods: 35 male Sprague-Dawley rats aged 6-8 weeks were divided into 7 groups, control group; low, medium, and high doses of soy milk; and low, moderate, and high doses of genistein. The treatment was given orally for 60 days. The control used was mice with standard feed. On the 61st day, blood and hepatic tissue samples were taken and checked for lipid profiles using the Friedewald formula. Statistical analysis was carried out by one-way ANOVA and Tukey's posthoc test and Dunnet test, then regression analysis. Results: There was a significant increase in total cholesterol levels (p <0.05) and LDL levels in low and moderate doses of soy milk group compared to all groups of genistein. There was no significant differences in HDL levels in soya and genistein groups. There was significant increase in Triglyceride levels in all groups of soy milk and low and moderate doses of Genistein compared to high doses of genistein. Conclusion: Soya and genistein supplementation had increased effect on the Total Cholesterol, LDL and Triglycerides but no effect on HDL in all groups.

Renal Artery Stenosis: Diagnostic and Management Problems

Renal artery stenosis is one common clinical problem. It has wide spectrum of pathophysiology with 3 most common clinical syndromes, ischemic nephropathy, hypertension, and cardiac destabilization syndrome. Aim: To date there was not any specific diagnostic criteria for renal artery stenosis. Method: Clinicians only used some clinical syndromes to guide the diagnostic possibility of renal artery stenosis. RADUS as one sensitive and specific diagnostic method, still had some disadvantages. Results: it gives false negative results in 10-20% of patients due to confounding factors such as operator capability, obesity, or abdominal gas distribution. CTA and MRA was excellent, but possessed some risks for the patient. Therefore, CTA was mostly recommended in patient with the planning of revascularization. Management of renal artery stenosis was still debated between optimal medical management and revascularization because the complexities of mechanisms underlying the renal artery stenosis. Because of the complicated pathophysiology of renal artery stenosis, revascularization could not entirely improve renovascular hypertension and nephropathy. Revascularization offered best results in fibromuscular dysplasia, although procedure related complication was still high. Revascularization, even though it might have high success rate in atherosclerotic renal artery stenosis, but the incidence of re-stenosis was also fairly high. Conclusion: Overall, revascularization was recommended in FMD, but should only be preserved for atherosclerotic renal artery stenosis after the failure of optimal medical management.

Comparison of Diagnostic Value between Point of Care Testing (POCT) and Standardize HbA1c Testing in Primary Health Care

Diabetes Mellitus is one of the biggest health problems. HbA1c is used to diagnose, to monitor treatment and treatment adjustment. High Performance Liquid Chromatography (HPLC) and electron spray mass spectrometry are recommended to measure HbA1c. But both methods need expensive cost, facility, and potentially increase health cost burden. HbA1c measurement using Point of Care Testing (POCT) is developed in Indonesia. POCT is more comfortable, has lower cost and easily brought to primary health care. Aim: to assess the clinical efficacy of POCT compared with a standard examination by HPLC. Methods: It is a cross-sectional observational study conducted at a first-level health facility (FKTP) in Malang. The subject population was patients who went to an outpatient unit in FKTP with inclusion criteria aged 20-75 years, were participants in the chronic disease management program (PROLANIS), both diabetes and non-diabetes. Results: Three hundred and thirty eight subjects were participated in this study. Five subjects were excluded because the presence of anemia. We used Wilcoxon test to compare HbA1c level between two methods and Rank Spearman correlation test to find correlation between two methods. This study showed measurement HbA1c level using POCT method had good accuracy (>80%). Other than diagnosis value, increased utilization of POCT HbA1c might also be caused by its portability and patient’s comfort. Conclusions: This study showed a strong correlation (R=0.016) between POCT HbA1c and standardized measurement. POCT HbA1c also showed good accuracy in all HbA1c groups.

The Effect of Vitamin E on Oral Mucositis Induced by Chemotherapy in Non-Hodgkin Lymphoma Patients Receiving Chemotherapy

Chemotherapy-induced mucositis is a side effect of chemotherapy that often occurs in patients with solid tumors and lymphoma. Oral mucositis can affect nutritional status and the risk of infection, both local and systemic. Antioxidant Vitamin E is beneficial for the prevention and therapy of both oral and gastrointestinal mucositis. Aim: To determine the effect of vitamin E therapy on the incidence of oral mucositis in non-Hodgkin lymphoma (NHL) patients receiving chemotherapy. Methods: This is a single-blind experimental study in 62 NHL patients undergoing chemotherapy who meet the inclusion criteria. Patients who met the inclusion criteria were randomly divided into 2 groups, namely 31 patients (treatment group) received vitamin E 400 mg / IU per day for 7 days and 31 patients in the placebo group. The incidence and grade of oral mucositis were observed on day 7. Statistical analysis used Chi-Square and Mann Whitney test according to the data type. Results: a total of 67% NHL patients were male, most of whom were over 46 years of age and as many as 50% of patients used chemotherapy regimens RCHOP and CHOP. There was an incidence of oral mucositis in 35% in the placebo group and 12.9% in the treated group (p = 0.038). In the placebo group, there were 4.8% of patients with grade 2 and 3 oral mucositis, which was not found in the therapy group. Conclusion: treatment with vitamin E in NHL patients undergoing chemotherapy can prevent chemotherapy-induced oral mucositis and prevent its severity.